A Prospective Observational Study to Assess the Efficacy of Intrathecal Levobupivacaine versus Bupivacaine in Elderly Patients Undergoing Lower Abdominal Surgeries

Abstract

 Introduction: With a growing elderly population, anaesthesia techniques must balance efficacy with safety. Spinal anaesthesia is preferred in geriatric patients due to reduced systemic effects compared to general anaesthesia. However, the choice of local anaesthetic—levobupivacaine or bupivacaine—remains a crucial determinant of perioperative outcomes. Levobupivacaine, the S(-) enantiomer of bupivacaine, is known for lower cardiotoxicity and neurotoxicity.

Materials and Methods: This prospective observational study was conducted from September 2022 to September 2024 in the Department of Anaesthesiology at a tertiary care hospital. A total of 70 elderly patients (aged ≥ 65 years) scheduled for lower abdominal surgeries under spinal anaesthesia were enrolled. Patients were divided into two groups: Group L (intrathecal hyperbaric levobupivacaine) and Group B (intrathecal hyperbaric bupivacaine). Parameters recorded included onset of sensory and motor block, time to reach T10 level, maximum block height, haemodynamic changes, total duration of block, regression to L5 level, and complications. Statistical analysis was conducted using SPSS software, with p < 0.05 considered significant.

Results:Both groups showed comparable onset of sensory and motor block (p > 0.05). The duration of motor block was significantly shorter in the levobupivacaine group (176.3 ± 14.2 minutes) than in the bupivacaine group (191.7 ± 16.1 minutes) (p < 0.05). Haemodynamic stability was better in the levobupivacaine group, with fewer incidences of hypotension and bradycardia. No major complications were observed in either group. Patient satisfaction and quality of anaesthesia were comparable.

Conclusion:Levobupivacaine and bupivacaine provide similar quality of spinal anaesthesia in elderly patients undergoing lower abdominal surgeries. However, levobupivacaine offers better haemodynamic stability and faster motor recovery, making it a safer alternative in geriatric patients